When Going up in Smoke is a Good Thing

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Date
June 4, 2021
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Something kept nagging at Kelechi Enweruzo-Amaefule. He had helped transport, lock away and incinerate unusable pharmaceutical products to keep them from landing in the black market or harming the environment. But now that they had been destroyed, he puzzled over what to do with the remaining, potentially toxic, ash. He and the managing director of the waste treatment facility where the unused pharmaceuticals were destroyed put their heads together and came up with a solution.

“One part this, two parts of that, three parts of that and we got the right ratio,” said Enweruzo-Amaefule, senior program manager for the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project in Nigeria. “I was so excited … to convert a room full of expired or unusable pharmaceuticals that could have gotten into the markets and caused a whole havoc to a community or a state. We reduced it to a brick.”

The bricks contain a mixture of clay, cement and the “bottom ash” from incineration. Normally, the ash is buried in a pit. But Rivers State, where the incineration facility is located, has a high water table and the ash could potentially leech toxins that would end up in people’s water supply. Now, the ash is contained in the bricks, which facility staff use for walkways and low walls at the site.

Mixing Ash        Making Brick        Final Brick

Dealing with waste from unused, expired or spoiled pharmaceuticals is a global challenge, especially in countries that have less developed systems of waste disposal. And the challenge continues to grow as populations expand. Nigeria, Africa’s most populous country, produced nearly 116 tons—more than the weight of the space shuttle—of HIV and malaria pharmaceutical waste alone in 2018, according to a Global Fund waste drive report. When considering many of the medications come in bubble packs, the volume necessary to reach the weight of a spacecraft is enormous.

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Enweruzo-Amaefule’s story illustrates just one of the many innovative means that GHSC-PSM staff utilize to achieve USAID’s goals and those of the project’s Environmental Compliance Unit and its Waste Management Plan to protect people and the environment. GHSC-PSM has been working with country governments around the globe to efficiently and safely dispose of unused pharmaceutical products that it procures and delivers for the past five years.

Pharmaceuticals can be unused because of overstock and expiry, some form of damage or improper storage, or replacement of medication regimen. When these products are improperly disposed of, people can scavenge them from landfills or small waste sites adjacent to health facilities and sell them on the black market, potentially threatening the health of consumers.

These items also carry USAID branding, which could prompt consumers to reject drugs procured by the Agency and distributed by GHSC-PSM if they thought they were unsafe or ineffective. This could further threaten the health of those who need treatment for HIV, malaria, or other illnesses or want contraceptives. If disposed of improperly, these products could also harm the environment and consequently communities.

“It’s very important that any waste coming out of health care facilities or warehouses is appropriately dealt with to prevent any harm,” said Janine Berger, Environmental Compliance Unit senior specialist. “We send it directly to an authorized incinerator or even aligned landfill instead of just sending it to any location and dumping. We want to make sure that it’s going to government-authorized locations. That is one of our requirements under the project.”

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Advancing Waste Management in Haiti
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Different countries have varying degrees of success with waste management. Haiti, which struggles with ongoing sociopolitical turmoil, cannot currently manage its own waste, and pollution is a serious problem in urban areas. The 2010 earthquake produced tons of waste, including pharmaceutical products, because donors around the world sent more to the country than could be managed and used. About 40 tons of unused pharmaceutical products are generated in Haiti each year, and international donors procure at least 70 percent of them, said Emmanuel Le Perru, deputy country director for GHSC-PSM in Haiti. Of those, USAID and the Global Fund purchase more than two-thirds.

Since the earthquake, USAID had been collecting and storing the expired or unused products it had procured in a secure warehouse because the government said there was no means to incinerate them. But this was costly and unsustainable. Eventually, Haiti gave USAID permission to export the products through a private company to France, where they were incinerated and converted to energy.

GHSC-PSM then worked with the Ministry of Health to come up with a sustainable disposal plan. They were able to identify two hospital incinerators that burned at the necessary temperature of 850 degrees Celsius (1,562 degrees Fahrenheit). The ministry recently signed an operational plan and is developing a memorandum of understanding with the two facilities for destroying a specific amount of unused pharmaceutical products each year.

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Thinking up Front for Tomorrow
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Sustainability, environmental protection and safeguarding health go hand in hand. GHSC-PSM has been working toward sustainability and waste reduction by exploring the environmental implications of changes to the secondary and tertiary packaging of key family planning products. The exploration of greener packaging configurations will take place as part of an ongoing GHSC-PSM activity focused on identifying opportunities to harmonize packaging offerings with UNFPA and optimize packaging to meet the needs of in-country supply chains.

This year, GHSC-PSM will engage a sustainable packaging expert to assess the environmental impacts of recommendations for harmonized and optimized packaging and explore other opportunities for decreasing environmental impact through packaging. This assessment will include an analysis of options to reduce carbon emissions and the use of single-use plastic and cardboard. GHSC-PSM expects results from the assessment toward the end of 2021, which will inform further recommendations for changes to the secondary and tertiary packaging of key family planning products.

Overall, whether through transport, incineration or packaging, GHSC-PSM continues to explore ways to minimize the impact of pharmaceutical products on the environment and further safeguard the health of those who consume them.

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